Time since first sexual intercourse and the risk of cervical cancer.
Time since first sexual intercourse and the risk of cervical cancer.
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DOI：
10.1002/ijc.26250
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发表时间：
2012-06-01
影响因子：
6.4
通讯作者：
Franceschi, Silvia
中科院分区：
文献类型：
--
作者：
Plummer, Martyn;Peto, Julian;Franceschi, Silvia
关键词：
初次性交时的年轻年龄是宫颈癌的一个重要危险因素，但尚未建立其影响的简单统计模型。我们使用来自国际宫颈癌流行病学研究协作组的一夫一妻制妇女（5,074例和16,137例对照）的数据，调查了宫颈癌风险与首次性交时间之间的关系。采用条件Logistic回归，从20项研究的汇总数据中估计比值比（OR）和95%置信区间（CI）。浸润性宫颈癌的OR与从第一次性交到45岁的时间的平方近似成正比（指数1.95，95%CI：1.76-2.15）。第一次宫颈感染人乳头瘤病毒（HPV）通常发生在第一次性交后不久，因此第一次性交的早期年龄是第一次接触HPV的早期年龄的合理代表。此外，未筛查人群中宫颈癌的年龄特异性发病率在45岁以上保持相当稳定。因此，宫颈癌类似于由强早期致癌物引起的其他癌症，发病率与首次接触后的时间幂成正比，也类似于乳腺癌和其他乳腺癌依赖性上皮癌，在绝经变化开始时，年龄特异性发病率也类似地趋于平缓。综上所述，这些观察结果表明，HPV疫苗接种可以通过延迟HPV感染来预防大多数宫颈癌，而不一定提供针对HPV的终身保护。
Young age at first sexual intercourse is an important risk factor for cervical cancer, but no simple statistical model of its influence has been established. We investigated the relationship between risk of cervical carcinoma and time since first intercourse using data on monogamous women (5,074 cases and 16,137 controls) from the International Collaboration of Epidemiological Studies of Cervical Cancer. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from pooled data on 20 studies using conditional logistic regression. The OR for invasive cervical carcinoma is approximately proportional to the square of time since first intercourse (exponent 1.95, 95% CI: 1.76–2.15) up to age 45. First cervical infection with human papillomavirus (HPV) often occurs soon after first sexual intercourse, so early age at first sexual intercourse is a reasonable proxy for early age at first exposure to HPV. In addition, age-specific incidence rates of cervical cancer in unscreened populations remain fairly constant above age 45. Cervical cancer thus resembles other cancers caused by strong early-stage carcinogens, with incidence rates proportional to a power of time since first exposure and also resembles cancers of the breast and other hormone-dependent epithelia where a similar flattening of age-specific incidence rates is seen at the time menopausal changes start. Taken together, these observations suggest that HPV vaccination may prevent the majority of cervical cancers by delaying HPV infection without necessarily providing lifetime protection against HPV.
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